Description: Elevate your audit strategy. Access 7 top educational resources designed to help healthcare compliance leaders navigate complex commercial and federal reviews.
Trying to get a better handle on audit readiness? Good move. To save you some time, we’ve curated this audit-related content specifically for healthcare compliance professionals. The overview compilation gives you a quick look at the useful advice in each resource, so you can dive right into where you need help the most.
If you haven’t thought about audit readiness lately, it’s probably time to put some focus on it. However, we know compliance life moves fast, and you can’t always get to some of the important things proactively.
Compliance leaders get exhausted by resource scarcity, manual tracking fatigue, and escalating payer audits. According to the Barnes & Thornburg Compliance Outlook Report, 56% of healthcare compliance and risk leaders anticipate even greater regulatory challenges ahead, with over half struggling to secure the resources needed to keep up.
So yeah, a proactive audit strategy could be a good idea.
Healthcare Compliance Audits: 7 Essential Resources for Leaders
Given that, it’s not surprising that continuous readiness is becoming the new standard for healthcare compliance leaders when it comes to audits.
This collection is about shifting the conversation from “surviving the next audit” to “building a defensible, tech-forward compliance data engine”.
These resources will quickly get you headed down a good path, with their abundant advice and useful tips from compliance professionals for compliance professionals. Many of them come with their own downloadable tip sheets.
Think of the collection as the start of your “audit preparedness playbook.”
Resource 1 – With Compliance Audits, The Best Defense is a Good Offense
Is your organization defensible against a compliance audit? Do you have a game plan in place to avoid penalties and other losses?
Traditional point-in-time random sampling simply fails to catch systemic gaps that audits can reveal.
How this resource helps:
With this blog, learn how to prepare your compliance program for the win. Using sports training analogies, the authors present a better way to handle ongoing inspections and audits in healthcare systems.
The fast-break transition offense the authors suggest is inspired by the 1990 UNLV Running Rebels basketball team. Get their unique advice on how to go offense following a regulatory compliance audit or inspection, so you’re well-prepared for the next one.
It takes practice. By reinforcing these principles and working on conditioning and decision making, teams can create more scoring opportunities. Just as a prepared team can force the defense into difficult situations, a well-prepared compliance team can “force” the auditor into zero-findings and more quality inspections.
Resource 2 – Audit Readiness? How about Audit Etiquette?
When a regulator shows up, what’s the first thing your team scrambles to find?
- Is it evidence of task completion?
- Maybe a list of applicable regs or updated policies?
- How about proof of communication to stakeholders?
In addition to documentation, how your team behaves during an audit also affects the outcome.
How this resource helps:
Learn the unfiltered truth about compliance audits and “audit etiquette” — the proper behavior for responding to an audit.
Get expert tips on:
- What audit readiness means
- The role of healthcare compliance auditors
- What to do (and what not do) during an audit
- Audit etiquette best practices
Perception is reality. If you look like you know what you’re doing, respond promptly, and treat the auditors with respect, you can generally minimize any damage. With the advice in this blog, you won’t just look ready; you’ll be ready – and calm.
Follow these practices and display confident compliance audit behavior.
Resource 3 – Healthcare Audit? Stay Ready. Don’t Get Ready.
Compliance audit in Quality? Many quality teams think they’re ready, until they aren’t.
In healthcare quality departments, audit readiness is no different than in any other area. Follow a defined process, then optimize as necessary so it works for your organization and patients.
It’s not hard, but people still panic because an auditor can shut them down.
However, if you have a proactive process in place to minimize the damage, you don’t have to worry.
How this resource helps:
This resource shares the pre-audit steps you need for proactive compliance readiness in Quality. It’s jammed with advice from the first word to the last.
- During the Compliance Audit
- Post-Audit Follow-Up Practices
- Be Proactive: Prepare for Your Next Compliance Audit
Resource 4 – How to Use TPE Plans for Compliance Auditing and Monitoring
When doing periodic risk assessments, compliance professionals often use the OIG Work Plan or DOJ enforcement actions to determine how to deploy time and resources on auditing and monitoring.
Another helpful tool is the list of services that Medicare Administrative Contractors (MACs) include in their Target, Probe and Educate (TPE) plans. According to CMS, the goal of TPE is to accelerate improvement and let MACs work with providers to correct specific errors.
How this resource helps:
As this expert-written piece explains, TPE information can be a good resource for compliance leaders when designing proactive audit plans.
This blog looks at how TPE plans are applied to specific areas of non-compliance that MACs observe. Use them to create your own checklists for cleaner compliance audits and proactive monitoring.
Resource 5 – Six key steps to reduce the impact of telehealth audits
Did you know telehealth is almost as old as the telephone itself?
In 1879, just three years after Bell patented the telephone, an article in The Lancet first described the telehealth concept and its use.
And a law that’s even older than the telephone still triggers telehealth audits today.
The 1863 False Claims Act was enacted to keep profiteering contractors from defrauding the Union army. Today, it can trigger serious problems for modern telehealth practitioners.
How this resource helps:
Today we know the best way to cope with audits is to avoid the need for them in the first place. This article shares six proactive steps to take to reduce the impact of telehealth audits.
It includes advice on how to:
- Know what you’re up against.
- Inventory your waivers.
- Check your records.
- Audit your process.
- Fix what’s broken.
- Rebill and repay.
Patient demand for telehealth isn’t going away. Neither are the costs of noncompliance with telehealth regulations.
By proactively partnering with colleagues in relevant departments, your compliance team can lead the efforts to identify and fix issues before they become major problems. That way, you can provide the telehealth services patients want in compliance with what the regulations demand.
Resource 6 – 5 Payer Audit Errors Every Hospital Must Avoid
From large hospitals to solo practitioners, at some point most providers will experience a commercial payer audit from CMS, OCR or some other agency. Their scrutiny reveals errors and violations, which in turn trigger hefty penalties. In fact, commercial payer audits have jumped 2.2 times over a single year, increasing the total sum at risk for hospital systems by 30%.
Even more challenging, payers are moving heavily toward pre-payment audits. These can hold up payments and squeeze monthly cash flow.
External payer audits don’t have to be such a nightmare.
How this resource helps:
The key to surviving an external audit with the least pain is to avoid the five payer audit errors outlined in this blog.
- Late responses
- Wrong documentation
- Billing the wrong codes
- No self-audit
- No legal help
By staying prepared and vigilant, your next payer audit experience can be more streamlined and less stressful.
Resource 7 – Audit Expectations and Challenges
When it comes to providing best-in-class healthcare, stress comes with the territory. Unrelenting demands drain resources across the organization, including some not directly involved with patient care.
One demand that turns daily routines upside down, and compounds stress levels is an audit. A compliance audit can be conducted internally by hospital committees or externally, often by government-approved contractors.
Internal Audit – Seeks to determine provider’s financial and operational controls, and that related policies and procedures meet compliance and risk management needs.
External Audits – Several federal agencies including CMS, OIG, OCR and others are the primary drivers of audits of regulations and compliance costs across hospitals. Responding to multiple external audits increases administrative costs, and funds could be bound up in lengthy appeals.
How this resource helps:
Study this overview to familiarize yourself with the basic workings and typical costs associated with audits. For example, external audits are conservatively estimated at $100 per hour, but the manual drain goes deeper:. Standard program reviews require 300 to 346 hours of direct manual labor per plan, taking skilled leaders away from higher-level risk mitigation.
The Tech-Driven Path to a Proactive Audit Strategy
You have plenty of insightful and helpful resources to review here. But as you look through them, keep this reality check in mind: 40% of compliance teams still rely on spreadsheets and text documents to track internal reviews.
The future belongs to compliance leaders who lean into automated tools, allowing their teams to complete risk assessments far faster than manual methods and catch errors before federal or commercial auditors flag them.
If you’re ready to leave the spreadsheets behind, or just have questions about setting up your proactive audit framework, we’re always here to talk.
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